Int Endodontic J - 2022 - Kirkevang - Outcomes Reporting in Systematic Reviews On Non Surgical Root Canal Treatment A

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Received: 28 April 2022 Accepted: 8 August 2022
DOI: 10.1111/iej.13812
REVIEW ARTICLE
Outcomes reporting in systematic reviews on non-surgical

root canal treatment: A scoping review for the development
of a core outcome set
Lise-Lotte Kirkevang1 | Ikhlas A. El Karim2 | Henry Fergus Duncan3 |

Venkateshbabu Nagendrababu4 | Casper Kruse1
1
Department of Dentistry and Oral Abstract
Health, Aarhus University, Aarhus,
Background: Studies related to non-surgical root canal treatment are amongst the
Denmark
2
School of Medicine, Dentistry
most frequently performed clinical studies in endodontics. However, heterogeneity
and Biomedical Sciences, Queen's in reporting outcomes and lack of standardization is a significant challenge to evi-
University Belfast, Belfast, UK dence synthesis and guideline development.
3
Division of Restorative Dentistry
Objectives: The aims of the present scoping review were to (a) identify outcomes
& Periodontology, Dublin Dental
University Hospital, Trinity College reported in systematic reviews evaluating non-surgical root canal treatment; (b)
Dublin, Dublin, Ireland identify how and when the reported outcomes were measured; (c) assess possible se-
4
Department of Preventive and lective reporting bias in the included studies. The information obtained in this study
Restorative Dentistry, College of Dental
Medicine, University of Sharjah,
should inform the development of a core outcome set (COS) for non-surgical root
Sharjah, UAE canal treatment.
Methodology: Structured literature searches were performed to identify systematic
Correspondence
Lise-Lotte Kirkevang, Department of reviews on non-surgical root canal treatments published in English between January
Dentistry and Oral Health, Aarhus 1990 and December 2020. Two reviewers undertook study selection and data extrac-
University, Vennelyst Boulevard 9, 8000
tion. Outcomes were categorized according to a healthcare taxonomy into five core
Aarhus C, Denmark.
Email: llki@dent.au.dk areas (survival, clinical/physiological changes, life impact, resource use, and adverse
events). The outcome measurement tools and length of follow-up were recorded.
Results: Seventy-five systematic reviews were included, of which 40 included meta-
analyses. Most reviews reported on physiological and clinical outcomes, primarily
pain and/or radiographic assessment of periapical status, and a variety of measure-
ment tools and scales were used. Few reviews focused on tooth survival, life impact,
resources, and adverse events. The heterogeneity amongst the reviews was large on
all parameters. Less than 40% of the reviews assessed the risk of selective reporting.
Discussion: Overall aims of the included reviews were highly heterogenic; thus,
outcomes and how they were measured also varied considerably. Patient-centred
outcomes and the use of resources were rarely reported on.
Conclusions: Most studies reported on physiological and clinical outcomes, in par-
ticular pain and/or radiographic healing. Measurement tools, scales, thresholds, and
follow-up periods varied greatly within each outcome, making comparison across
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© 2022 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.
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1128 wileyonlinelibrary.com/journal/iej
Int Endod J. 2022;55:1128–1164.
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13652591, 2022, 11, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/iej.13812 by Cochrane Romania, Wiley Online Library on [11/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
KIRKEVANG et al. 1129
studies complicated. Less than 40% of the reviews assessed risk of selective reporting;
thus, selective bias could not be ruled out. The presented information on reported
outcomes, measurement tools and scales, and length of follow-up may guide the
planning of future research and inform the development of a COS for non-surgical
root canal treatment.
KEYWORDS
clinician-reported outcome, core outcome set, outcome, patient-reported outcome, root canal
treatment, scoping review
I N T RO DU CT ION possible benefits from evidence synthesis in systematic

reviews and meta-analyses (Cushley et al., 2019; Cushley
The aim of non-surgical root canal treatment is to pre- et al., 2021; El Karim et al., 2022; Wu et al., 2009). As part
vent or treat apical periodontitis and is at the centre of of the process of establishing a COS for endodontic treat-
the discipline of endodontics. Numerous studies have ment, an identification and thorough review and analy-
been undertaken to improve and refine all steps in the sis of previously employed measures and outcomes are
treatment, from diagnosis, access preparations, chemo- needed.
mechanical disinfection, to restoration of the root filled Endodontics encounter different treatment modalities:
tooth (Kirkevang & Væth, 2019). non-surgical root canal treatment, surgical endodontic
The primary aim of a systematic review is to retrieve treatment, vital pulp treatment, and regenerative end-
and synthesize available information on a specific treat- odontic therapy. Since the aims and outcomes of different
ment modality using strict methodological parameters and treatment modalities vary, separate scoping reviews have
preferably perform a meta-analysis in which the combina- to be performed for each treatment modality (El Karim
tion of results from individual studies is used to increase et al., 2021, 2022).
the statistical power and precision of the effect estimate of The aims of the present scoping review were to:
a given intervention (Clarke & Williamson, 2016). The op-
portunities for doing quality meta-analysis are, however, a. Identify outcomes reported in systematic reviews eval-
often limited due to heterogeneity within the reported uating non-surgical root canal treatment.
outcome measures from the included studies. Hence, b. Identify how and when the reported outcomes were
many systematic reviews are confined to summarizing the measured.
reported findings of the included studies. To homogenize c. Assess possible selective reporting bias in the included
the reporting of outcomes amongst studies, establishing studies.
a minimum set of standardized outcomes would enable
researchers to more easily combine and compare research The information obtained in this study should in-
results within a subject (Adams et al., 2013). Such a stan- form the development of COS for non-surgical root canal
dardized set is referred to as a core outcome set (COS), treatment.
defined as a standardized collection of the minimum out-
comes that should be measured and reported for a spe-
cific area of health (Clarke & Williamson, 2016). COS METHODS
may increase the likelihood that important outcomes are
measured, improve evidence synthesis by reducing hetero- Protocol registration and reporting
geneity between studies, and reduce outcome-reporting guidelines
bias to improve the validity of the study (Clarke, 2008; El
Karim et al., 2022). A protocol for the Development of Core Outcome Sets
In the field of endodontics, clinical studies have tradi- for Endodontic Treatment modalities (COSET) was de-
tionally focused on clinician-reported outcomes, which veloped and registered in COMET (El Karim et al., 2021).
are measured by clinical and/or radiographic examina- The COSET protocol was based on COS-STAP Statement
tion, whereas patient-reported outcomes are less fre- (Kirkham et al., 2016). The methodology followed Core
quently employed (Duncan et al., 2021). Unfortunately, Outcome Sets for Endodontic Treatment modalities
the lack of standardization between studies, for exam- (COSET), and the report followed PRISMA-ScR guide-
ple in radiographic evaluation criteria, have limited the lines (Page et al., 2021; Tricco et al., 2018).
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1130 OUTCOMES IN NON-SURGICAL ROOT CANAL TREATMENT
Selection criteria of Science, Cochrane Database of Systematic Reviews.

Systematic reviews published between January 1990 and
The present review focused on non-surgical root canal December 2020 were identified. Depending on the data-
treatment. Inclusion and exclusion criteria are described base and search engine keywords, MeSH terms and filters
in Table 1. were used. Keywords included the following: endodontic,
endodontics, root canal treatment, root canal therapy,
root canal filling, pulpectomy, pulpectomies, root canal
Literature search obturation, root canal retreatment. All retrieved stud-
ies were imported to Endnote 20 (Clarivate Analytics,
Structured literature searches were performed by two re- Philadelphia, PA) and thereafter moved to Covidence
viewers (LLK, CK) using PubMed, Embase, OVID, Web (Covidence, Melbourne, Australia) for reviewers´ as-
sessment. Identification of duplicates was performed by
T A B L E 1 Inclusion and exclusion criteria specific tools in Endnote and Covidence. All identified
duplicates were reviewed, and removal was approved by
Inclusion criteria Exclusion criteria
hand if appropriate. Title and abstract screening and full-
Language Published in English Published in any text review were performed individually by both review-
other language
ers (Figure 1). Any disagreement about article inclusion
Study types Systematic reviews with or All other study types was resolved by discussion. The detailed search strategy is
without meta-analysis
presented in Table S1.
Population Patients who received Patients <18 years
non-surgical root Animal studies
canal treatment in a
permanent tooth
Data extraction and categorization
Patients who received into domains
non-surgical root
canal retreatment in a Two reviewers (LLK, CK) were involved in data extrac-
permanent tooth tion, and any disagreement was resolved by discussion.
Intervention Non-surgical root canal Any other treatment For the selected reviews, data were extracted using be-
treatment modality spoke data extraction forms. The data extraction form was
Non-surgical root canal piloted on three papers and modified as necessary before
retreatment use. For each included review, the following information
Outcomes Clinician-reported outcome Inter-appointment was retrieved: First author, publication year, country of
and patient-reported assessment corresponding author, journal name, aim/research ques-
outcomes
tion, outcomes, meta-analysis (yes/no). The data were fur-
Follow-up All No restrictions ther classified into core areas using the health taxonomy
Period Published between January Published during all described by (Dodd et al., 2018) and included the follow-
1990 and December 2020 other periods ing: tooth survival, clinical and physiological changes,
969 studies excluded (initial

1570 studies were identified
screening on title, duplicates)
601 studies screened on title and

452 studies irrelevant and excluded
abstract
149 full-text studies assessed for

74 studies excluded
eligibility
37 wrong study design
7 not full-text/not original article
6 insufficient information on data
6 wrong intervention
75 studies included
5 no outcome reported
3 wrong patient population
3 full text not retrievable
F I G U R E 1 PRISMA flowchart
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life impact, use of resources and adverse effects. Within et al., 2020; Aminoshariae & Kulild, 2015; Aminoshariae
these core areas, the outcomes were further grouped into & Kulild, 2020; Anagnostaki et al., 2020; Basmadjian-
a number of outcome domains (Table 2). Charles et al., 2002; Bergenholtz et al., 2013; Bordea
et al., 2020; Borges Silva et al., 2017; Borgo Sarmento
et al., 2020; Căpută et al., 2019; Chércoles-Ruiz
RES ULT S et al., 2017; Chrepa et al., 2014; Cope et al., 2014; Cope
et al., 2018; Cunha et al., 2020; Decurcio et al., 2019; Del
Literature search Fabbro et al., 2007; Del Fabbro et al., 2016; Del Fabbro
et al., 2018; Fedorowicz et al., 2012; Figini et al., 2007;
In total, 149 reviews were eligible for full-text re- Fransson et al., 2013; Gillen et al., 2011; Gupta et al., 2020;
view, 74 were excluded for various reasons (Table S2). Hou et al., 2017; Iqbal & Kim, 2007; Jamali et al., 2018;
The included studies comprised 75 systematic re- Kang et al., 2015; Kojima et al., 2004; Kruse et al., 2015;
views, of which 40 included meta-analyses (Table 3); Leong et al., 2020; Leong & Yap, 2019; Manfredi
(Abdulrab et al., 2018; Almeida et al., 2017; Alonaizan & et al., 2016; Martins et al., 2020; Matthews et al., 2003;
AlFawaz, 2019; Aminoshariae et al., 2017; Aminoshariae Mello et al., 2019; Moreira et al., 2019; Nagendrababu
et al., 2019; Nasrabadi et al., 2020; Neelakantan, Ahmed,
et al., 2019; Neelakantan et al., 2020; Neelakantan,
T A B L E 2 Core areas with outcome domains and reported
Herrera, et al., 2019; Ng et al., 2007; Ng et al., 2010;
outcome measures
Ng, Mann, & Gulabivala, 2008; Ng, Mann, Rahbaran,
Reported outcome et al., 2008; Nixdorf et al., 2010; Olivieri et al., 2020; Pak
Core area Outcome domain measures & White, 2011; Panitvisai et al., 2010; Peng et al., 2007;
Tooth survival Tooth survival Patient history and Pourhajibagher & Bahador, 2019; Ruksakiet et al., 2020;
clinical examination Sadaf et al., 2020; Sathorn et al., 2005; Sathorn et al., 2007;
Physiological Pain Patient history, visual Schaeffer et al., 2005; Schwendicke & Göstemeyer, 2017;
and clinical pain scale and Shakiba et al., 2017; Siddiqui et al., 2013; Silva et al., 2019;
clinical examination Smith et al., 2017; Spohr et al., 2019; Su et al., 2011;
Swelling or sinus Clinical examination Suneelkumar et al., 2018; Susila & Minu, 2019; Torabinejad
tract et al., 2007; Torabinejad et al., 2009; Trindade et al., 2015;
Tissue tenderness Clinical examination Wong et al., 2017; Yaylali et al., 2018).
Tenderness to Clinical examination For all the included reviews, the reported outcomes,
percussion the measurement tools and scales, the length of follow-up,
Mobility Clinical examination and the risk of reporting bias were described.
Bacterial reduction Clinical investigation
and microbiological
sampling Characteristics of studies
Biomarker Clinical investigation
expression and sampling The characteristics of included studies are presented in
Periodontal pocket Clinical examination Table 3. Five core areas were applied: Survival, physi-
depths ological and clinical outcomes, life impact, resource use,
Radiographic or Radiographic and adverse effects (Table 2). For each reported outcome,
CBCT healing examination the following were assessed: core area, outcome domain,
Life impact Need for sick leave Patient history reported outcome measurement tool, and length of fol-
Fatigue reduced Patient history low-up (Tables 4–8). Further description of criteria and
energy diagnostic scales applied in the included studies are pre-
Discomfort Patient history sented in Table S3.
A limited number of systematic reviews reported on
Oral Health-related Patient history
Quality of life tooth survival (n = 8) (Table 4), life impact (n = 5) (Table 6),
resource use (n = 19) (Table 7) and adverse effects (n = 5)
Resource use Need for medication Patient history
(Table 8). The main proportion of the systematic reviews
Adverse events Exacerbation Patient history and
reported on physiological and clinical outcomes (n = 66),
clinical examination
primarily pain (n = 28), and radiographic assessment of
Gastro-intestinal Patient history
periapical status (n = 39) or a combination of both clinical
Hypersensibility Patient history
and radiographic measures (n = 18) (Table 5).
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T A B L E 3 Overview of included systematic reviews
Country of Meta-
corresponding analysis
First author Year author Journal name Aim /Research question Outcomes (Y/N)
Abdulrab, S. 2018 Saudi Arabia Journal of To critically appraise and Primary outcome: Y
Endodontics summarize the available postoperative
evidence on the effect of pain, secondary
maintaining AP during outcome analgesic
endodontic therapy consumption.
considering postoperative
pain as the main outcome.
Almeida, D. O. 2017 Brazil Journal of The present meta-analysis Cured/not cured, Y
Contemporary evaluated the outcomes of presence/absence of
Dental Practice endodontic treatment of pain, and negative/
non-vital teeth at a single positive cultures.
visit repair, microbiological
control, and postoperative
pain.
Alonaizan, F. A. 2019 Saudi Arabia Photodiagnosis To answer the PICOS what is Pain. Reports of any N
and the effect of phototherapy adverse events.
Photodynamic (Intervention) as compared
Therapy to placebo (Comparator) on
postoperative endodontic
pain (Outcomes) considering
only RCTs (Study design)?
Anagnostaki, E. 2020 United Dentistry Journal To evaluate which field of laser Postoperative pain. N
Kingdom (conventional lasers alone
and lasers combined with
photosensitizers for root
canal disinfection, laser in
postoperative-endodontic
pain management) is
most strongly supported
by clinical evidence, and
if so, which shows more
favourable results than
application of the gold
standard (endodontic)
treatment alone
Aminoshariae, A. 2015 USA International In patients with restorable teeth Microbial load in N
Endodontic that have had persistent the canal system,
Journal periapical pathosis and/ measured using
or clinical symptoms, is microbiological
there an optimal apical sampling methods
enlargement which would and analyses.
result in better microbial
reduction?
Aminoshariae, A. 2017 USA Journal of To evaluate the relationship Clinical/radiographic N
Endodontics between systemic diseases healing and/or
and outcomes in endodontic survival of the tooth.
treatment.
Aminoshariae, A. 2020 USA Australian To qualify and quantify the Healing in terms Y
Endodontic evidence regarding extruded of clinical and
Journal sealers and their influence radiographic
on endodontic treatment evaluation.
outcomes.
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T A B L E 3 (Continued)
Country of Meta-
Aminoshariae, A. 2020 USA Clinical Oral To evaluate the relationship Endodontic failure: N
Investigations between CVD and outcomes endodontic survival,
in endodontic treatment. PAI.
Asmadjian- 2002 France International To delineate the factors Treatment outcome, N
Charles, C. L. Dental Journal which may be taken into combinations
account in a consensus of clinical and
about endodontic therapy. radiographic criteria.
A review of the currently
available literature is
presented including the
factors influencing the
outcome of endodontic
treatments. Moreover,
a consensus of author's
findings regarding the
impact of these factors
on long-term results of
endodontic treatment is
proposed.
Bergenholtz, G. 2013 Sweden Singapore Dental How effective are the different Healing. N
Journal methods for preserving the
pulp in a vital, asymptomatic
condition in teeth with deep
caries? How effective is
pulpectomy in comparison?
What factors may influence
healing after a pulpectomy
procedure?
Bordea, I. R. 2020 Italy and United Photodiagnosis Which laser treatment protocol, Healing and bacterial N
Kingdom and amongst various laser count.
Photodynamic applications is the most
Therapy effective in root canal
disinfection with optimal
outcome?
Borges Silva, E. A. 2017 Brazil Journal of To investigate whether Postop pain, flare-up, Y
Endodontics currently available evidence swelling, and
supports a relationship analgesic
between foraminal consumption.
enlargement during
endodontic treatment and
postoperative symptoms.
The clinical question was
structured according to
PICOS design, and the
question to be answered
was framed as follows: For
adult patients who undergo
endodontic treatment, does
foraminal enlargement
cause different postoperative
symptoms in comparison
with conventional
endodontic treatment?
|
Country of Meta-
Borgo Sarmento, 2020 Brazil European To answer the question based Postoperative pain. N
E. Endodontic on the PICOS strategy: Can
Journal sodium hypochlorite and
chlorhexidine influence
postoperative pain after the
endodontic treatment in
necrotic teeth?
Căpută, P. E. 2019 The Journal of To systematically review Improved healing of N
Netherlands Endodontics and critically analyse the apical periodontitis.
evidence on the cleaning
and disinfection of root
canals and the healing of
apical periodontitis when
ultrasonic irrigant activation
is applied during primary
root canal treatment of
mature permanent teeth
compared with syringe
irrigation.
Chércoles-Ruiz, 2017 Spain Journal of To answer the following clinical Success, incomplete/ N
A. Endodontics question: Which is the best uncertain/failure,
treatment option for a tooth survival.
with pulpal involvement?
Then, the following PICO
question was designed: In a
patient who has a tooth with
pulpitis, necrosis with or
without a periapical lesion,
in the presence or absence
of symptoms, and without
a radicular fracture, does
the conservative treatment
(endodontic treatment or
retreatment and/or apical
surgery) compared with
tooth extraction and implant
placement achieve higher
survival rates?
Chrepa, V. 2014 USA Journal of To investigate the effect of Microbial load, number N
Endodontics photodynamic therapy on of microbial species,
bacteria load reduction measured using
during root canal microbiological
disinfection. sampling methods
and analyses.
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Country of Meta-
Cope, A. L. 2014 United Cochrane To evaluate the effects of Pain, pain on Y

Kingdom Database of systemic antibiotics percussion,
Systematic provided with or without analgesics, postop
Reviews surgical intervention (such flare-up, swelling,
as extraction, incision and adverse effect.
drainage of a swelling or
endodontic treatment),
with or without analgesics,
for symptomatic apical
periodontitis or acute apical
abscess in adults.
Cope, A. L. 2018 United Cochrane To evaluate the effects of Pain, pain on N
Kingdom Database of systemic antibiotics percussion,
Systematic provided with or without analgesics, postop
Reviews surgical intervention (such flare-up, swelling,
as extraction, incision and analgesics, adverse
drainage of a swelling, or effect.
endodontic treatment),
with or without analgesics,
for symptomatic apical
periodontitis and acute
apical abscess in adults.
Cunha, T. C. 2020 Brazil BMC Oral Health To assess and compare, through Occurrence and N
a systematic review of intensity of
randomized clinical trials, intraoperative
the influence of glide or postoperative
path kinematics during pain, analgesics
endodontic treatment of consumption.
human permanent teeth
on the occurrence and
intensity of intraoperative
and postoperative pain.
The null hypothesis
tested was that there is no
difference between root
canal preparation without
glide path preparation or
with glide path preparation
using manual, continuous
rotary, or reciprocating
instruments regarding the
occurrence and intensity
of intraoperative and
postoperative pain.
Decurcio, D. A. 2019 Australia Journal of To assess if machine-assisted Postoperative pain. Y
Endodontics agitation resulted in less
postoperative pain compared
with syringe irrigation
with needle alone in adult
patients undergoing root
canal treatment in mature
teeth.
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Country of Meta-
Del Fabbro, M. 2007 Italy The Cochrane To test the null hypothesis of Success of the N
Library no difference in outcome re-treatment
between surgical and determined by
non-surgical therapy for clinical assessment
endodontic re-treatment of of signs and
periradicular lesions. symptoms,
combined with
examination
of periapical
radiographs
to evaluate
radiographic
healing.
Del Fabbro, M. 2016 Italy Cochrane To assess effects of surgical and Primary outcome: N
Database of non-surgical therapy for One-year healing
Systematic retreatment of teeth with of periapical
Reviews apical periodontitis and to pathosis evaluated
assess effects of surgical by assessment of
root-end resection under clinical signs and
various conditions, for symptoms (absence
example, when different of pain, suppuration,
materials, devices or swelling) and
techniques are used. through two-
dimensional or
three-dimensional
radiological
examination,
occurrence of postop
infection. Secondary
outcome: longer
follow-up.
Del Fabbro, M. 2018 Italy The Journal of To evaluate and compare the Primary outcomes: pain Y
Evidence-based effectiveness (outcome) of reduction, symptoms
Dental Practice using rNiTi (intervention) resolution and
versus mSST (comparison) healing, improvement
files in root canal-treated of quality of life,
teeth (population). occurrence of
complications,
tooth retention and
function, relapse
of the condition.
Secondary outcomes:
cleansing of the root
canal, microbial load
reduction, apical
debris extrusion,
transportation, and
centring ability.
Technical quality
of root canal filling,
length, density
(voids), and width
(tapering).
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Country of Meta-
Fedorowicz, Z. 2012 Switzerland Cochrane To assess the effects of irrigants Pain, new or worsening N
Database of used in the non-surgical root signs, symptoms
Systematic canal treatment of mature or both, of
Reviews permanent teeth. inflammation, that
is pain, redness,
swelling, heat, or
loss of function,
requiring a revisit,
health-related
quality of life,
satisfaction with
the procedure,
bacterial growth
culture, healing 2-d
radiography, CBCT.
Figini, L. 2007 Italy Cochrane To compare the effectiveness Tooth extraction due Y
Database of of single- and multiple-visit to endodontic
Systematic RCT, measured as tooth problems,
Reviews extraction due to endodontic Radiological failure,
problems and radiological Postoperative pain,
success. To assess the Swelling, Painkiller
difference in short- and long- use, Sinus track or
term complications between fistula formation.
single- and multiple-visit
RCT.
Fransson, H. 2013 Sweden International To evaluate the clinical efficacy Radiologically N
Endodontic of lasers as an adjunct confirmed normal
Journal to chemo-mechanical periapical conditions
disinfection with the or a reduction
outcome measures ‘normal in the number
periapical condition’ or or ratio of viable
‘reduction of microbial load’ microorganisms in
in infected root canals. the root canal and/
or adjacent dentine.
Gillen, B. M. 2011 USA Journal of To determine whether the quality Radiographic periapical Y
Endodontics of a coronal restoration or status.
the quality of a root canal
filling has a greater impact
on the outcome of root
canal treatment. The clinical
question to be answered in this
systematic review (a problem,
intervention, comparison and
outcome [PICO] question)
may be framed as follows:
in adult patients who have
had non-surgical root canal
treatment, does the presence
of an adequate root filling
and an inadequate coronal
restoration, compared with
the presence of an inadequate
root filling and an adequate
coronal restoration, result in a
worse clinical outcome?
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Country of Meta-
Gupta, A. 2020 India International To take into account all Radiolucent periapical Y
Endodontic the recent research on lesions.
Journal the possible correlation
between DM and root
canal treatment outcome
and aimed to conduct a
systematic review and
meta-analysis of prospective
clinical studies along with
an evaluation of data from
cross-sectional studies to
evaluate the impact of DM
on root canal treatment
outcome, assessed by the
prevalence or absence
of radiolucent periapical
lesions.
Hou, X. M. 2017 China BMC Oral Health To investigate whether PP Post-endodontic pain. Y
incidence following
single visit of root canal
preparation evaluated by
VAS was similar following
procedures using rotary and
reciprocating instruments.
To investigate whether
subgroup of the PP levels
was similar or not.
Iqbal, M. K. 2007 USA The International To systematically review clinical Tooth survival. N
Journal of Oral studies of the survival of
& Maxillofacial single-teeth implants and
Implants endodontically treated
and restored teeth and to
compare the results.
Jamali, S. 2018 Iran Annals of Medical The clinical and radiographic Healing rate of root Y
and Health assessment of two different canal treatment.
Sciences endodontic treatments of
Research one-and two-visit with apical
periodontitis.
Kang, M. 2015 South Korea Clinical Oral To evaluate and compare the Healing. Y
Investigations clinical and radiographic
outcomes of non-surgical
endodontic retreatment and
endodontic microsurgery
by calculating the weighted
pooled success rates.
Kojima, K. 2004 Japan Oral Surgery Oral To investigate the success Periapical status. Y
Medicine Oral rate of root canal filling
Pathology by evaluating factors such
as apical limit (short vs.
overextension), status of the
pulp (vital vs. non-vital), and
periapical status (presence
or absence of radiolucency).
|
Country of Meta-
Kruse, C. 2015 Denmark International To evaluate the diagnostic Radiographic healing. N

Endodontic efficacy of CBCT for
Journal periapical lesions, focusing
on the evidence level of the
included studies using a six-
tiered hierarchical model.
Leong, D. J. X. 2020 Singapore Clinical Oral To examine the treatment Tooth survival, Y
Investigations outcome of cracked teeth treatment success.
that received root canal
treatment and to determine
factors that influenced
outcome.
Leong, D. J. X. 2020 Singapore Australian To appraise the available data Quality of life. N
Endodontic on patient-centred quality of
Journal life outcomes of endodontic
treatment using the Joanna
Briggs Institute approach.
Manfredi, M. 2016 Italy Cochrane To determine whether Tooth extraction due Y
Database of completion of root canal to endodontic
Systematic treatment in a single visit problems;
Reviews or over two or more visits, Radiological failure;
with or without medication, Postoperative
makes any difference in pain; Swelling or
term of effectiveness or flare-up; Painkiller
complications. use; Sinus track;
Any complication
of adverse event
(short-term) (pain,
painkiller use,
swelling or flare-up).
Martins, C. M. 2020 Brazil Indian Journal To comprehensively review two Postoperative pain after Y
of Dental different irrigation solutions 24 h.
Research (sodium hypochlorite and
chlorhexidine) regarding
the postoperative pain after
endodontic treatment.
Matthews, D. C. 2003 Canada Journal of the To perform a systematic Absence of infection, Y
Canadian literature review and meta- absence of pain,
Dental analysis on the effectiveness or absence of both
Association of interventions used in the infection and pain.
management of acute apical
abscess in the permanent
dentition.
Mello, F. W. 2019 Brazil Clinical Oral To investigate the influence Root canal treatment N
Investigations of obturation extent on the outcome related to
final outcome of root canal root filling apical
treatment by answering extend.
the question amongst
patients requiring root canal
treatment on fully formed
permanent teeth, is there
an association between
obturation extent and the
final treatment outcome?
|
Country of Meta-
Moreira, R. N. 2019 Brazil Acta Odontologica To investigate whether there Systems effect on Y
Scandinavica are differences between endotoxin reduction
the root canal disinfection, from the root canal
comparing the passive system.
ultrasonic irrigation
technique with the
conventional technique.
Nagendrababu, V. 2019 Malaysia Journal of To find the most effective Postop pain controlled Y
Endodontics oral premedication in by medication.
reducing pain in adults
after non-surgical root canal
therapy using network
meta-analysis.
Nasrabadi, N. 2020 China Pesquisa To determine the impact of Endotoxin lessening Y
Brasileira em distinctive instrumentation during root canal
Odontopediatria systems of the root canals treatment.
e Clínica on the endotoxin lessening
Integrada through the root canals.
Neelakantan, P. 2019 Brazil International To answer the following Endotoxin levels after Y
Endodontic question: in patients chemomechanical
Journal with primary endodontic preparation.
infection, is there a
statistically significant
difference in the
endotoxin levels after
chemomechanical
preparation with
sodium hypochlorite or
chlorhexidine?
Neelakantan, P. 2019 Hong Kong Australian To address this issue, a Root canal Y
Endodontic systematic review was instrumentation
Journal conducted to answer the systems on
question: In patients with endotoxin reduction
endodontic infections, do from the root canal
instrumentation systems system.
differ significantly in
reduction of endotoxins
from the root canal system?
Neelakantan, P. 2020 Hong Kong Clinical Oral To systematically review the Oral health-related N
Investigations literature to determine the quality of life.
OHRQoL before and after
Ng, Y. L. 2007 United International To conduct a comprehensive Success based on N
Kingdom Endodontic systematic review of the clinical and/or
Journal literature on the outcome of radiographic criteria.
primary (initial or first time)
root canal treatment and to
investigate the influence of
some study characteristics
on the estimated pooled
success rates.
|
Country of Meta-
Ng, Y. L. 2008 United International To carry out meta-analyses to Success based on Y

Kingdom Endodontic quantify the influence of clinical and/or
Journal the clinical factors on the radiographic criteria.
efficacy of primary root
canal treatment and to
identify the best treatment
protocol based on the
current evidence.
Ng, Y. L. 2008 United International To investigate the effects of Success based on N
Kingdom Endodontic study characteristics on clinical and/or
Journal the reported success rates radiographic criteria.
of secondary root canal
treatment, and to investigate
the effects of clinical factors
on the success of secondary
root canal treatment.
Ng, Y. L. 2010 United International To investigate the effect of study Tooth survival after root Y
Kingdom Endodontic characteristics on reported canal treatment.
Journal tooth survival after root
canal treatment and the
effect of clinical factors on
the proportion of root filled
teeth surviving after root
canal treatment.
Nixdorf, D. R. 2010 USA Journal of To estimate the frequency of Persistent tooth pain Y
Endodontics persistent pain, regardless 6 M after RCT.
of aetiology, following
Olivieri, J. G. 2020 Spain Journal of To evaluate the success Success and Y
Endodontics and survival rate of survival rate of
endodontically treated endodontically
cracked posterior teeth and treated cracked
to assess the preoperative posterior teeth.
factors that affect teeth
survival.
Pak, J. G. 2011 USA Journal of To determine the influence Pain (pre-, intra-, Y
Endodontics of non-surgical root post-treatment).
canal treatment on pain
prevalence and severity
in adult patients and to
estimate the prevalence and
severity of pain experienced
before, during, and after root
canal treatment through
systematic review and
meta-analysis
|
Country of Meta-
Panitvisai, P. 2010 Thailand Journal of To determine the influence Healing for teeth with a Y
Endodontics of a retained instrument retained instrument
fragment on the prognosis fragment.
of root canal treatment.
The clinical question to be
answered in this systematic
review can be framed as
follows: in adult patients
who have had non-surgical
root canal treatment, does
the retention of a separated
instrument, compared
with no retained separated
instrument, result in a
poorer clinical outcome?
Peng, L. 2007 China Journal of To evaluate clinical outcome Postop pain. Long- Y
Endodontics differences of root canal term outcomes.
obturation by warm gutta- Obturation quality.
percha or cold lateral
condensation through
a systematic review and
meta-analysis.
Pourhajibagher, 2019 Iran Photodiagnosis To investigate the efficacy of Microbial load, Y
M. and antimicrobial photodynamic that is count of
Photodynamic therapy adjunctive to microorganisms.
Therapy conventional chemo-
mechanical debridement of
root canal system in patients
with endodontic infections.
Ruksakiet, K. 2020 Hungary Journal of To compare the antimicrobial Bacterial growth and Y
Endodontics efficacy of chlorhexidine count.
and sodium hypochlorite,
2 irrigants routinely used
in root canal therapy of
permanent teeth.
Sadaf, D. 2020 Saudi Arabia Journal of To evaluate the effect of Postop pain. Y
Endodontics intracanal cryotherapy on
postoperative pain after root
canal therapy in patients
with pulpal or periradicular
pathosis.
Sathorn, C. 2005 Australia International Does single-visit treatment Radiographic Y
Endodontic without calcium hydroxide definitions of
Journal dressing, compared to success and failure
multiple-visit treatment with were not consistent.
calcium hydroxide dressing
for 1 week or more, results
in a lower healing rate (as
measured by clinical and
radiographic interpretation)?
|
Country of Meta-
Sathorn, C. 2007 Australia International To determine to what extent Positive bacterial Y

Endodontic does calcium hydroxide cultures at different
Journal intracanal medication time-points during
eliminate bacteria from root canal treatment
human root canals, of teeth with apical
compared with the same periodontitis.
canals before medication,
as measured by the number
of positive cultures, in
patients undergoing root
canal treatment for apical
periodontitis (teeth with an
infected root canal system).
Schaeffer, M. A. 2005 USA Journal of To aid in assessing an optimal Radiographic success Y
Endodontics terminal point for root canal or failure and root
therapy to improve the canal obturation
prognosis. length.
Schwendicke, F. 2017 Germany BMJ Open In patients needing root canal Risk of long-term Y
treatment, is single-visit complications
treatment significantly more (defined as
effective than multiple-visit pain, infection/
treatment with regard to risk swelling/sinus
of long-term failure? The track formation,
secondary objective was to or development,
compare both treatments persistence or
with regard to risk of short- aggravation of
term postoperative pain as periapical lesions
well as the risk of flare-up. or widening of
the periodontal
ligament, etc.,
≥1). Risks of
experiencing any
short-term pain
(<1 year after
treatment) after
obturation or after
instrumentation or
after both.
Shakiba, B. 2017 USA Gerodontology To conduct a systematic review Success of tooth N
of longitudinal endodontic survival after root
outcomes in elders. canal treatment in
elderly (45–80 years
old).
Siddiqui, S. H. 2013 Saudi Arabia Photodiagnosis To review the bactericidal Bacterial count (e. N
and efficacy of photodynamic faecalis).
Photodynamic therapy against Enterococcus
Therapy faecalis in infected root
canals.
Silva, E. R. G. 2019 Brazil British Dental To evaluate the effectiveness Periapical healing, root N
Journal of passive ultrasonic canal disinfection.
irrigation compared with
non-activated irrigation on
periapical healing and root
canal disinfection.
|
Country of Meta-
Smith, E. A. 2017 USA Journal of To address the following: Postop pain. Y

Endodontics Population, Intervention,
Comparator, Outcome,
Timing, Study design and
setting question: in patients
with preoperative pain who
undergo initial orthograde
endodontic treatment, what
is the comparative efficacy
of NSAIDs compared with
non-narcotic analgesics
or placebo in reducing
postoperative pain and the
incidence of adverse events?
Spohr, A. R. 2019 Brazil Giornale Italiano To evaluate the influence Postop pain. N
di Endodonzia of hand, rotary
and reciprocating
instrumentation on
endodontic postoperative
pain.
Suneelkumar, C. 2018 India Journal of In patients with preoperative Postop pain. Y
Endodontics pain who undergo
single-visit non-surgical
endodontic treatment, what
is the comparative efficacy
of corticosteroids compared
with other analgesics
or placebo in reducing
postoperative pain and the
incidence of adverse events?
Su, Y. 2011 China Journal of To compare the healing rate Healing rate, post- N
Endodontics and post-obturation pain obturation pain.
of single-versus multiple-
visit root canal treatment
for teeth with infected root
canals.
Susila, A. 2019 India European To investigate the clinical Postoperative pain, N
Endodontic efficiency of mechanically periapical healing,
Journal activated irrigants and antibacterial
conventional irrigation. efficacy, canal
and/or isthmus
cleanliness,
debridement efficacy
and delivery up to
working length.
Torabinejad, M. 2007 USA The Journal of To compare the outcomes, Clinical and/or N
Prosthetic benefits, and harms of radiographic
Dentistry endodontic care and outcomes, survival
restoration compared to or success.
extraction and placement
of implant-supported
single crowns, fixed partial
dentures, or extraction
without tooth replacement.
|
Country of Meta-
Torabinejad, M. 2009 USA Journal of To compare the clinical and Clinical and/or N
Endodontics radiographic outcomes of radiographic
non-surgical retreatment outcomes.
with those of endodontic
surgery to determine which
modality offers more
favourable outcomes.
Trindade, A. C. 2015 Brazil Photomedecine To summarize the results of Bacterial presence/ N
and Laser research on photodynamic bacterial reduction
Surgery therapy in endodontics
published in peer-reviewed
journals
Wong, A. W. 2017 Hong Kong BMC Oral Health To evaluate the clinical Success-rate, postop Y
performance of core-carrier pain, overfilling,
obturation in endodontic canal adaptation.
treatment.
Yaylali, I. E. 2018 Turkey Journal of To determine the influence Postop, pain and N
Endodontics of maintaining AP during prevalence of
instrumentation on flare-ups.
postoperative pain severity
and the prevalence of flare-
ups. To assess the effect of
maintaining AP on the use
of analgesics.
T A B L E 4 Core area: Tooth survival
Outcome domain Reported outcome measure Duration of follow-up Systematic review cited
Tooth survival History and clinical exam 1 up to 2 years Manfredi et al. (2016; 1 study)
Olivieri et al. (2020; 7 studies)
2 up to 4 years Aminoshariae et al. (2017; 1 study)
Aminoshariae et al. (2020; 1 study)
Iqbal & Kim (2007; 2 studies)
Leong et al. (2020; 2 studies)
Torabinejad et al. (2007; 1 study)
>4 years Aminoshariae et al. (2017; 1 study)
Aminoshariae et al. (2020; 1 study)
Iqbal & Kim (2007; 11 studies)
Leong et al. (2020; 1 study)
Torabinejad et al. (2007; 6 studies)
Not specified Aminoshariae et al. (2017; 1 study)
Shakiba et al. (2017; 2 studies)
|
T A B L E 5 Core area: Physiological and clinical outcomes
Reported outcome measure

Outcome domain Measurement tool and scale Duration of follow-up Systematic review cited
Postoperative pain Visual analogue scale (VAS) (1–9) Up to 1 day Smith et al. (2017; 1 study)
Up to 2 days Figini et al. (2007; 1 study)
Up to 3 days Smith et al. (2017; 1 study)
Up to 7 days Abdulrab et al. (2018; 1 study)
Fedorowicz et al. (2012; 1 study)
VAS (1–10) Up to 1 day Nagendrababu et al. (2019; 2 studies)
Smith et al. (2017; 2 studies)
Spohr et al. (2019; 1 study)
Suneelkumar et al. (2018; 1 study)
Up to 2 days Borgo Sarmento et al. (2020; 1 study)
Decurcio et al. (2019; 3 studies)
Manfredi et al. (2016; 1 study)
Nagendrababu et al. (2019; 2 studies)
Pak & White (2011; 3 studies)
Sadaf et al. (2020; 4 studies)
Spohr et al. (2019; 2 studies)
Susila & Minu (2019; 1 study)
Yaylali et al. (2018; 1 study)
Up to 3 days Anagnostaki et al. (2020; 1 study)
Cope et al. (2014; 1 study)
Cunha et al. (2020; 2 studies)
Hou et al. (2017; 1 study)
Nagendrababu et al. (2019; 1 study)
Sadaf et al. (2020; 1 study)
Smith et al. (2017; 1 study)
Up to 7 days Abdulrab et al. (2018; 2 studies)
Alonaizan & AlFawaz (2019; 2 studies)
Anagnostaki et al. (2020; 6 studies)
Borges Silva et al. (2017; 3 studies)
Borgo Sarmento et al. (2020; 1 study)
Cope et al. (2018; 1 study) *included same studies as
Cope et al. (2014)
Decurcio et al. (2019; 3 studies)
Hou et al. (2017; 2 studies)
Manfredi et al. (2016; 2 studies)
Martins et al. (2020; 1 study)
Susila & Minu (2019; 3 studies)
Yaylali et al. (2018; 2 studies)
Up to 9 days Manfredi et al. (2016; 1 study)
Up to 2 months Borges Silva et al. (2017; 1 study)
Up to 6 months Anagnostaki et al. (2020; 1 study)
>1 year del Fabbro et al. (2016; 1 study)
VAS (1–100) Up to 1 day Nagendrababu et al. (2019; 4 studies)
Pak & White (2011; 1 study)
|

Up to 2 days Nagendrababu et al. (2019; 1 study)
Up to 3 days Nagendrababu et al. (2019; 5 studies)
Up to 4 days Pak & White (2011; 1 study)
Up to 5 days Pak & White (2011; 1 study)
Yaylali et al. (2018; 1 study)
VAS (1–150) Up to 2 days Smith et al. (2017; 1 study)
Modified Heft-Parker VAS (0–170) Up to 1 day Smith et al. (2017; 1 study)
Nagendrababu et al. (2019; 1 study)
Up to 7 days Sadaf et al. (2020; 1 study)
Binary scale (no pain, pain) Up to 2 days Matthews et al. (2003; 1 study)
Up to 3 days Matthews et al. (2003; 1 study)
Up to 4 days Pak & White (2011; 2 studies)
Up to 7 days Almeida et al. (2017; 6 studies)
del Fabbro et al. (2016; 1 study)
Matthews et al. (2003; 2 studies)
Su et al. (2011; 3 studies)
Up to 10 days Su et al. (2011; 1 study)
Up to 1 month Almeida et al. (2017; 2 studies)
Su et al. (2011; 1 study)
Up to 6 months Nixdorf et al. (2010; 1 study)
>6 months Nixdorf et al. (2010; 3 studies)
>1 year Manfredi et al. (2016; 2 studies)
Nixdorf et al. (2010; 8 studies)
Peng et al. (2007; 1 study)
|
Verbal Rating Scale (VRS), Numerical Up to 1 day Alonaizan & AlFawaz (2019; 1 study)
Rating Scale (NRS)
(3-point ordinal scale)
(no/mild, moderate, severe)
(Completely painless; mild pain, does not
affect occlusion and eating; severe
pain, affecting occlusion and eating)
(mild: require no treatment; moderate;
require and is relieved with analgesics;
severe is not relieved with analgesics)
Anagnostaki et al. (2020; 1 study)
Up to 3 days Anagnostaki et al. (2020; 2 studies)
Cope et al. (2014)
Figini et al. (2007; 1 study)
Up to 2 weeks Fedorowicz et al. (2012; 1 study)
Up to 1 month Figini et al. (2007; 2 studies)
VRS, NRS Up to 1 day Smith et al. (2017; 2 studies)
(no, mild/slight, moderate, severe)
Up to 2 days Borges Silva et al. (2017; 1 study)
Smith et al. (2017; 1 study)
Figini et al. (2007; 2 studies)
Up to 1 month Figini et al. (2007; 1 study)
VRS, NRS Up to 1 day Smith et al. (2017; 1 study)
(no, mild/slight, moderate, severe, very
severe, extremely severe)
Up to 3 days Cunha et al. (2020; 1 study)
Up to 7 days Fedorowicz et al. (2012; 1 study)
VRS, NRS Up to 1 day Smith et al. (2017; 1 study)
(no pain, slight pain, moderate pain, strong
pain, severe pain, maximum pain)
Up to 7 days Manfredi et al. (2016; 1 study)
VRS, NRS (10-point ordinary scale) Up to 3 days Anagnostaki et al. (2020; 1 study)
CR 10 Borg list Up to 2 days Decurcio et al. (2019; 1 study)
|


No scale/subjective/unspecified Up to 1 day Borgo Sarmento et al. (2020; 1 study)
Symptoms Patient history (Unspecified) Up to 1 day Aminoshariae & Kulild (2015; 1 study)
(yes/no)
Up to 7 days Alonaizan & AlFawaz (2019; 5 studies)
Swelling or sinus tract Clinical exam Up to 2 days Borgo Sarmento et al. (2020; 1 study)
(Swelling: Y/N)
Clinical exam Up to 7 days Cope et al. (2014; 1 study)
(Swelling: mild/moderate/severe) Cope et al. (2018; 1 study) *included same studies as
Cope et al. (2014)
Up to 2 weeks Fedorowicz et al. (2012; 1 study)
Clinical exam Up to 3 days Cope et al. (2014; 1 study)
(Swelling: no/mild/moderate/severe) Cope et al. (2018; 1 study) *included same studies as
Cope et al. (2014)
Clinical exam (Sinus tract: Y/N) Up to 7 days Manfredi et al. (2016; 1 study)
Tenderness to percussion Clinical exam (yes/no, 0/1/2/3) Up to 3 days Anagnostaki et al. (2020; 2 studies)
Cope et al. (2014)
Tissue tenderness (palpation) Clinical exam (yes/no) >1 year Manfredi et al. (2016; 3 studies)
Periodontal pocket depths Clinical exam (yes/no) >1 year Manfredi et al. (2016; 3 studies)
Mobility Clinical exam (yes/no) >1 year Manfredi et al. (2016; 3 studies)
Bacterial reduction Clinical investigation and microbiological undefined Ng, Mann, Rahbaran, et al. (2008; 12 studies)
sampling, Culture test (undefined)
>4 years Ng, Mann, Rahbaran, et al. (2008; 2 studies)
Clinical investigation and microbiological Before root filling Almeida et al. (2017; 4 studies)
sampling. Bacterial count (binary:
present/not present)
Bordea et al. (2020; 2 studies)
|
Neelakantan, Ahmed, et al. (2019; 1 study)

4 years Bergenholtz et al. (2013; 1 study)
Clinical investigation and microbiological Until root filling Aminoshariae & Kulild (2015; 6 studies)
sampling, Bacterial load (before and
after instrumentation)
Anagnostaki et al. (2020; 4 studies)
Del Fabbro et al. (2018; 2 studies)
Fedorowicz et al. (2012; 4 studies)
Fransson et al. (2013; 3 studies)
Pourhajibagher & Bahador (2019; 6 studies)
Ruksakiet et al. (2020; 5 studies)
Sathorn et al. (2007; 8 studies)
Siddiqui et al. (2013; 1 study)
Trindade et al. (2015; 4 studies)
Until 2 weeks Chrepa et al. (2014; 3 studies)
>4 years Ng, Mann, Rahbaran, et al. (2008), Ng, Mann, &
Gulabivala (2008; 14 studies)
Clinical investigation and microbiological After root filling Aminoshariae & Kulild (2015; 1 study)
sampling, Bacterial load (after root
filling, surgical removal of apex)
Clinical investigation and microbiological Until root filling Bordea et al. (2020; 3 studies)
sampling, Bacterial type
Chrepa et al. (2014; 2 studies)
Pourhajibagher & Bahador (2019; 1 study)
Clinical investigation and microbiological Until root filling Fedorowicz et al. (2012; 3 studies)
sampling, Colony forming unit
(CFU)/real-time quantitative-
polymerase chain reaction (qRT-PCR)/
epifluorescence microscopy (EFM)
Moreira et al. (2019; 3 studies)
Pourhajibagher & Bahador (2019; 4 studies)
Ruksakiet et al. (2020; 3 studies)
Up to 4 years Ruksakiet et al. (2020; 1 study)
Biomarker expression Clinical investigation and sampling, Until root filling Bordea et al. (2020; 1 study)
endotoxins (Chromogenic LAL assay)
Neelakantan, Ahmed, et al. (2019; 3 studies)
+
Radiographic assessment of Periapical radiographs, PAI ( = radiology 6 up to 12 months Anagnostaki et al. (2020; 1 study)
development/healing of and clinical findings combined)
lesion
Jamali et al. (2018; 1 study)
Manfredi et al. (2016; 2 studies+)
Mello et al. (2019; 1 study)
Sathorn et al. (2005; 1 study)
2 up to 4 years Manfredi et al. (2016; 1 study+)
>4 years Mello et al. (2019; 2 studies)
|

Sathorn et al. (2005; 1 study)

Other combinations Sathorn et al. (2005; 1 study) (6 months–5 years)
Susila & Minu (2019; 1 study) (10–19 months)
Not specified Aminoshariae et al. (2017; 2 studies)
Gillen et al. (2011; 9 studies)
Gupta et al. (2020; 5 studies)
Periapical radiographs, Rud & Molven 1 up to 2 years Del Fabbro et al. (2007; 1 study+)
(+ = radiology and clinical findings
combined)
Del Fabbro et al. (2016; 1 study+)
2 up to 4 years Panitvisai et al. (2010; 1 study+)
>4 years Torabinejad et al. (2009; 5 studies)
Not specified Shakiba et al. (2017; 1 study)
Periapical radiographs (Complete, >4 years Figini et al. (2007; 1 study)
incomplete, no healing)
Periapical radiographs, Strindberg's criteria 2 up to 4 years Manfredi et al. (2016; 1 study+)
combined)
Not specified Gupta et al. (2020; 3 studies)
Shakiba et al. (2017; 2 studies) (possible
6–360 months)
Periapical radiographs, 1 up to 2 years Basmadjian-Charles et al. (2002; 1 study+)
Strindberg's + Bender's criteria
combined)
>4 years Basmadjian-Charles et al. (2002; 4 studies+)
Other combinations Basmadjian-Charles et al. (2002; 5 studies+) (1–9 year)
Periapical radiographs, radiolucency (Y/N) 6 up to 12 months Wong et al. (2017; 1 study+)
combined)
1 up to 2 years Mello et al. (2019; 1 study+)
Wong et al. (2017; 1 study+)
2 up to 4 years Figini et al. (2007; 1 study+)
Manfredi et al. (2016; 1 study+)
Mello et al. (2019; 1 study+)
Wong et al. (2017; 8 studies+)
>4 years Del Fabbro et al. (2007; 1 study)
Del Fabbro et al. (2016; 1 study)
Mello et al. (2019; 4 studies+)
Ng et al. (2007; 2 studies)
Ng et al. (2007; 2 studies+)
Ng, Mann, & Gulabivala (2008; 2 studies)
Ng, Mann, & Gulabivala (2008; 5 studies+)
Other combinations Bergenholtz et al. (2013; 1 study) (Up to 3 years)
Ng et al. (2007; 16 studies) (6 months–4 years)
Ng et al. (2007; 19 studies+) (6 months–4 years)
Ng, Mann, Gulabivala (2008; 7 studies+)
(6 months–4 years)
|
Su et al. (2011; 6 studies) (6 months–5 years)

Wong et al. (2017; 1 study+) (6 months–24 months)
Periapical radiographs, periapical <6 months Fransson et al. (2013; 1 study)
lesion size or changed in lesion size
combined)
1 up to 2 years Leong et al. (2020; 1 study+)
2 up to 4 years Manfredi et al. (2016; 1 study+)
>4 years Ng et al. (2007; 1 study+)
Ng, Mann, Gulabivala (2008; 1 study+)
Other combinations Mello et al. (2019; 1 study) (1–12 years)
Ng et al. (2007; 15 studies+) (6 months–4 years)
Ng et al. (2007; 8 studies) (6 months–4 years)
Ng, Mann, Gulabivala (2008; 1 study)
Ng, Mann, Gulabivala (2008; 1 study+)
Susila & Minu (2019; 1 study+) (10–19 months)
Not specified Schwendicke & Göstemeyer (2017; up to 29 studies+)
Periapical radiographs, healing of 6 up to 12 months Jamali et al. (2018; 1 study)
periapical lesion (+ = radiology and
clinical findings combined)
1 up to 2 years Almeida et al. (2017; 2 studies)
Aminoshariae & Kulild (2020; 1 study)
Jamali et al. (2018; 2 studies)
2 up to 4 years Almeida et al. (2017; 2 studies)
Aminoshariae & Kulild (2020; 2 studies)
Jamali et al. (2018; 1 study)
>4 years Almeida et al. (2017; 2 studies)
Aminoshariae & Kulild (2020; 3 studies)
Other combinations Bordea et al. (2020; 1 study+) (21–31 months)
Figini et al. (2007; 1 study+) (6 months–2 years)
Manfredi et al. (2016; 1 study+) (6 months–2 years)
Periapical radiographs, treatment success 1 up to 2 years Olivieri et al. (2020; 3 studies)
(not further specified)
2 up to 4 years Schaeffer et al. (2005; 4 studies)
>4 years Torabinejad et al. (2007; 6 studies)
Periapical radiographs, treatment success 6 up to 12 months Kang et al. (2015; 1 study+)
(PAI 1 or 2, or reduction in/absence of
periapical lesion)
combined)
1 up to 2 years Kang et al. (2015; 2 studies+)
2 up to 4 years Kang et al. (2015; 2 studies+)
>4 years Kang et al. (2015; 2 studies+)
|

Periapical radiographs 1 up to 2 years Mello et al. (2019; 1 study+)

(Success, uncertain, failure)
combined)
2 up to 4 years Chércoles-Ruiz et al. (2017; 1 study)
>4 years Chércoles-Ruiz et al. (2017; 2 studies+)
Chércoles-Ruiz et al. (2017; 3 studies)
Figini et al. (2007; 1 study+)
Manfredi et al. (2016; 1 study+)
Other combinations Panitvisai et al. (2010; 1 study+) (1–4 years)
Periapical radiographs, PDL widening >4 years Mello et al. (2019; 2 studies+)
(Y/N)
combined)
Periapical radiographs, Smith's criteria 6 up to 12 months Kojima et al. (2004; 2 studies+)
combined)
1 up to 2 years Kojima et al. (2004; 1 study+)
>4 years Kojima et al. (2004; 4 studies+)
Other combinations Kojima et al. (2004; 14 studies+)
Not specified Kojima et al. (2004; 4 studies+)
Periapical radiographs 1 up to 2 years Peng et al. (2007; 3 studies)
(Not specified)
combined)
Ruksakiet et al. (2020; 1 study)
Gupta et al. (2020; 1 study)
Peng et al. (2007; 2 studies)
>4 years Peng et al. (2007; 1 study)
Ruksakiet et al. (2020; 1 study)
Not specified Aminoshariae et al. (2017; 3 studies+)
Aminoshariae et al. (2017; 5 studies)
Gupta et al. (2020; 1 study)
Shakiba et al. (2017; 4 studies+)
Panoramic radiographs, PAI Not specified Gupta et al. (2020; 3 studies)
Panoramic radiographs, Strindberg's Not specified Gupta et al. (2020; 1 study)
criteria
Panoramic radiographs (not specified) Not specified Aminoshariae et al. (2017; 2 studies)
CBCT, Radiolucency (Y/N)(Y = PDL space 2 up to 4 years Kruse et al. (2015; 1 study)
>0.5 mm)
Other combinations Căpută et al. (2019; 1 study)
Silva et al. (2019; 1 study)
Not specified Kruse et al. (2015; 5 studies)
|
CBCT, Periapical lesion size or changed in Other combinations Căpută et al. (2019; 1 study) (10–19 months)
lesion size
Silva et al. (2019; 1 study) (10–19 months)
Susila & Minu (2019; 1 study) (10–19 months)
Not specified Kruse et al. (2015; 2 studies)
CBCT, PAI Not specified Kruse et al. (2015; 1 study)
CBCT, Six categories 1 up to 2 years Kruse et al. (2015; 1 study)
(new AP, enlarged AP, unchanged AP,
reduced AP, resolved AP, healthy
periapical status)
CBCT, Five categories Not specified Kruse et al. (2015; 1 study)
(based on the characteristics of the bone
plates next to the apex)
CBCT, Healing after non-surgical 1 up to 2 years Del Fabbro et al. (2016; 1 study)
retreatment
(Y/N)
Pain was most often assessed by use of a pain scale The clinical parameters swelling, sinus tract, tender-
and the patient history. There was marked variation in ness to percussion or palpation, periodontal pockets, and
the type of measurement tools and thresholds for pain, mobility of the tooth were reported infrequently, and with
including various versions of the Visual Analogue considerable variation in assessment tool and criteria.
Scale; measuring on scales from 1–9 to 0–1 70, and Furthermore, the follow-up period varied. Swelling and
Verbal Rating Scale or Numerical Rating Scale; mea- sinus tract were primarily assessed within the first weeks
suring on 2–10 point scales. Furthermore, in many or months after treatment, whereas the other clinical pa-
studies different combinations of pain measurements rameters were assessed after longer follow-up period of
and radiographic assessments were used as the re- 1 year or more (Table 5).
ported outcome measures. For pain, the follow-u p pe- Bacterial reduction was assessed in 18 studies (Table 5).
riod varied considerably from <1 day up to more than The most common feature amongst these studies was that
1 year. Most studies were, however, reporting pain up they reported on very short follow-up periods, primarily
to 7 days after treatment (Table 5). ranging from before the start of root canal treatment and
Radiographic assessment of periapical status was gen- until root filling procedure. Only a few studies (n = 4) re-
erally performed using periapical radiography. The radio- ported on effect of bacterial presence at time of root filling
graphic criteria used for assessment varied considerably, on long-term follow-up (up to 4 years).
as did the length of follow-up. The measurement tool most The effect of non-surgical root canal treatment on the
often used for radiographic follow-up was the Periapical patient's quality of life was reported on less often (n = 5).
Index (Ørstavik et al., 1986) applied in 12 studies, followed A few studies (n = 3) reported on short-term discomfort or
by ‘radiolucency or not’ (n = 11). The radiographic criteria fatigue, restricted to the days immediately after the treat-
for healing by Rud et al. (1972) were applied in several ment had been performed. Only one study reported on
studies on non-surgical endodontic retreatment (n = 9) patients’ need for sick leave in relation to the treatment.
even though the criteria originally were developed to as- Within the few included studies, the outcome measure
sess outcome in relation to surgical endodontic retreat- varied considerably (Table 6).
ment. Some studies reported on radiographic outcome More studies (n = 19) reported on need for medica-
after a follow-up period of 6 months, but most studies re- tion, primarily if the patient had need of analgesics. The
ported after 1–4 years. Panoramic radiographs were rarely follow-up ranged from 1 day to 1 year or more (Table 7). In
used (n = 2). Cone beam computed tomography (CBCT) addition, adverse effects were reported in a few studies, in
was used in a few studies (n = 6), but the disease criteria form of exacerbation, with a follow-up of 2 days to 2 months,
varied considerably, and the follow-up periods varied be- and gastro-intestinal problems, which were reported in two
tween 1–4 years (Table 5). studies, with a short follow-up of a few days (Table 8).
|
T A B L E 6 Core area: Life impact

Discomfort Patient history (Y/N) Up to 1 day Borgo Sarmento et al. (2020; 1 study)
Fatigue/reduced energy Patient history (Y/N) Up to 3 days Cope et al. (2014; 1 study)
Cope et al. (2018; 1 study) *included same
studies as Cope et al. (2014)
Need for sick leave Patient history >1 year del Fabbro et al. (2016; 1 study)
(Y/N)
Oral Health-related Patient history (OHIP-14, Up to 1 month Neelakantan et al. (2020; 4 studies)
Quality of life OHIP-17)
(OHRQoL)
Up to 6 months Neelakantan et al. (2020; 1 study)
Up to 5 years Neelakantan et al. (2020; 3 studies)
Not specified Neelakantan et al. (2020; 1 study)
Patient history (Patient Up to 7 days Neelakantan et al. (2020; 3 studies)
Perception Questionnaire)
Patient history (Modified Up to 1 year Neelakantan et al. (2020; 1 study)
Health-related Quality of
Life Index)
Patient history (OQOL measure 3 months Neelakantan et al. (2020; 1 study)
6 items and 12 items)
Patient history (Ad hoc Up to 7 days Neelakantan et al. (2020; 1 study)
postoperative QoL)
Patient history (American Up to 7 days Neelakantan et al. (2020; 1 study)
Chronic Pain Association
quality of life scale)
Selective reporting bias treatment modality, they most often posed different re-
search questions with focus on different aspects of treat-
The tools most often used for risk of bias assessment were ment, and consequently, they reported using a variety of
the Cochrane tools. Of the 75 included reviews, 29 as- outcomes, measurement tools, and follow-up periods.
sessed selective reporting bias in the included studies, 17 However, variation in research questions was not the en-
of these assessed all studies to have a low risk of selec- tire explanation of the heterogenic outcomes, since even
tive reporting bias and few studies were assessed as being studies with similar aims chose to report outcome differ-
in high risk of selective reporting bias. The overall risk of ently. This is also reflected in the fact that in only 40 out of
bias in the studies often was assessed as moderate to high 75 (53%) included systematic reviews meta-analysis was
(Table 9). performed.
In the present scoping review, 18 outcome domains
within five core areas were identified (Table 2). In a recent
DI S C US S I O N study, focusing on non-surgical root canal treatment, non-
surgical retreatment, and apexification procedures, an
The present scoping review aimed to provide an overview almost similar number of outcome measures were identi-
of outcomes, outcome measures, measurement tools and fied (n = 19) (Azarpazhooh, Sgro, et al., 2022).
follow-up periods used in studies on non-surgical root The outcomes most often reported on were within the
canal treatments. The collected information should be physiological and clinical core area. The outcome mea-
used to inform the development of a COS for non-surgical sures being primarily pain and radiographic healing, and
root canal treatment. in many studies, combinations of pain measurements
It was shown that even though the included system- and radiographic assessments were used. This approach
atic reviews all report on outcomes related to the same has been integrated in some of the measurement tools,
|
T A B L E 7 Core area: Resource use

Measurement tool and Duration of
Outcome domain scale follow-up Systematic review cited
Need for medication Patient history, analgesics Up to1 day Nagendrababu et al. (2019; 6 studies)
(Y/N, sometimes type-dose) Smith et al. (2017; 4 studies)
Suneelkumar et al. (2018; 3 studies)
Up to2 days Figini et al. (2007; 1 study)
Suneelkumar et al. (2018; 2 studies)
Up to3 days Borgo Sarmento et al. (2020; 1 study)
Cope et al. (2014)
Cunha et al. (2020; 3 studies)
Up to 7 days Abdulrab et al. (2018; 3 studies)
Almeida et al. (2017; 6 studies)
Borges Silva et al. (2017; 4 studies)
Borgo Sarmento et al. (2020; 1 study)
Cope et al. (2014)
Hou et al. (2017; 2 studies)
Martins et al. (2020; 2 studies)
for example Bender's criteria (Bender et al., 1966; Smith relevant, but may also further complicate comparisons
et al. 1993; Table S3), but with varying description of both amongst studies.
the radiographic and the pain assessments. These com- For pain, the follow-up period often was relatively
binations of clinician-reported outcomes and patient- short, up to 1 week after treatment, whereas longer fol-
reported outcomes may be as regarded very clinically low-up periods were less frequent. For radiography, the
|
T A B L E 8 Core area: Adverse effects
Reported outcome
measure
Measurement tool and
Outcome domain scale Duration of follow-up Systematic review cited
Exacerbation Patient history, flare-up (Y/N) Up to2 days Figini et al. (2007; 1 study)
(no relief or an increase in
the severity of pain no
resolution or an increase
in the size of swelling,
fever, trismus or difficulty
swallowing; signs of a
drug allergy or any other
abnormal symptoms)
Up to 3 days Cope et al. (2014; 1 study)
Gastro-intestinal Patient history (Y/N) Up to 1 day Nagendrababu et al. (2019; 1 study)
Up to 3 days Cope et al. (2014; 1 study)
Patient history (mild/ Up to 2 months Borges Silva et al. (2017; 1 study)
moderate/severe)
Hypersensitivity Clinical exam (mild/ Up to 2 months Borges Silva et al. (2017; 1 study)
moderate/severe)
follow-up period most often was longer, ranging from was also shown in a recent scoping review reporting on
6 months to more than 4 years. four decades of outcomes in non-surgical root canal treat-
Few studies reported on the other defined core ment (Azarpazhooh, Sgro, et al., 2022). Obvious explana-
areas: tooth survival, life impact, resource use, and ad- tions for this are related to differences in time-period and
verse events. Tooth survival is probably the most im- availability of the newer, more advanced methods. Care
portant outcome from a patient's perspective. However, should therefore be taken not to overestimate the impor-
few studies report on this parameter as the primary tance of high numbers of studies reporting on a specific
outcome. Similarly, few studies report on the effect of outcome measure, and care should also be taken to ensure
a root canal treatment on the patient's quality of life, that relevant information from historic research is trans-
even though this also must be considered highly rele- latable, if a newer methodology for outcome assessment
vant for, and by, the patients. A recent scoping review is endorsed.
looking at original studies reported similar findings, Non-surgical root canal treatment consists of many
that clinical and radiographic outcomes were fre- steps, for example diagnosing, obtaining anaesthesia,
quently reported, whereas patient-centred outcomes assess preparation, locating root canals, irrigation, and
were reported less frequently (Azarpazhooh, Sgro, each step should be performed in an optimal manner in
et al., 2022). The lack of focus on the patient perspec- order to obtain an optimal prognosis for the tooth and
tive is problematic. Therefore, it is important to include the patient. When performing a randomized controlled
patient representatives in the development of a COS (El trial, one parameter is investigated whilst maintaining
Karim et al., 2021). all other variables constant. This, of course, results in a
In the included systematic reviews, traditional out- huge variety of outcome measures, which all may inde-
come measures (e.g. bacterial count, periapical imaging) pendently affect the outcome of the treatment. However,
were reported on more often, compared to more advanced it is of importance to also report on the overall treat-
diagnostics methods (e.g. biomarkers, CBCT). This trend ment outcome, in particular viewed from the patients'
|
T A B L E 9 Selective reporting bias, and overall bias in studies related to non-surgical root canal treatment
Method for assessing risk of bias Selective reporting risk

First author Year (RCT/CCT) of bias Overall risk of bias
Abdulrab, S. 2018 Cochrane Collaboration tool All low 2 low, 3 high
Almeida, D. O. 2017 No Not reported
Alonaizan, F. A. 2019 No Not reported
Anagnostaki, E. 2020 Cochrane Risk of Bias tool, modified All low 12 low, 5 moderate
Aminoshariae, A. 2015 Joanna Briggs Institute Critical Not reported 5 low, 2 moderate
Appraisal tool
Aminoshariae, A. 2017 Cochrane Collaboration tool 5 low, 10 high 6 moderate, 12 high
Aminoshariae, A. 2020 Newcastle-Ottawa scale Not reported All moderate
Aminoshariae, A. 2020 Newcastle-Ottawa scale 2 low, 1 moderate All low
Basmadjian-Charles, 2002 No Not reported
C. L.
Bergenholtz, G. 2013 defined in article Not reported 1 moderate
Bordea, I. R. 2020 No Not reported
Borges Silva, E. A. 2017 Cochrane Collaboration tool All low 3 low, 2 high
Borgo Sarmento, E. 2020 Cochrane Collaboration tool All low 2 low, 3 high
Căpută, P. E. 2019 defined in article Not reported 3 medium
Chércoles-Ruiz, A. 2017 No Not reported
Chrepa, V. 2014 Consort, Strobe Not reported 2 moderate, 1 high
Cope, A. L. 2014 Cochrane Collaboration tool 1 low, 1 unclear 1 unclear, 1 high
Cope, A. L. 2018 Cochrane Collaboration tool 1 low, 1 unclear 1 unclear, 1 high
Cunha, T. C. 2020 Joanna Briggs Institute Critical Not reported 3 moderate, 3 high
Appraisal tool
Decurcio, D. A. 2019 Cochrane Risk of Bias All low 3 low, 3 some concerns
Del Fabbro, M. 2007 Cochrane Collaboration tool Not reported 1 moderate, 1 high
Del Fabbro, M. 2016 Cochrane Collaboration tool 12 low, 8 unclear
Del Fabbro, M. 2018 Cochrane Collaboration tool All low 1 low, 3 high
Fedorowicz, Z. 2012 Cochrane Collaboration tool 10 low, 1 high 2 low, 6 unclear, 3 high
Figini, L. 2007 Cochrane Collaboration tool Not reported 4 low, 4 moderate, 4 high
Fransson, H. 2013 No Not reported
Gillen, B. M. 2011 No Not reported
Gupta, A. 2020 Joanna Briggs Institute Critical 3 low, 7 high 3 low, 1 moderate, 6 high
Appraisal tool
Hou, X. M. 2017 Cochrane Risk of Bias All low All low
Iqbal, M. K. 2007 No Not reported
Jamali, S. 2018 No Not reported
Kang, M. 2015 No Not reported
Kojima, K. 2004 No Not reported
Kruse, C. 2015 No Not reported
Leong, D. J. X. 2020 Joanna Briggs Institute Critical Not reported
Appraisal tool
Leong, D. J. X. 2020 Joanna Briggs Institute Critical Not reported
Appraisal tool
Manfredi, M. 2016 Cochrane Risk of Bias 22 low, 1 unsure, 2 high 3 low, 8 unclear, 14 high
Martins, C. M. 2020 Cochrane Collaboration tool All low
Matthews, D. C. 2003 No Not reported
|
Method for assessing risk of bias Selective reporting risk
First author Year (RCT/CCT) of bias Overall risk of bias
Mello, F. W. 2019 Meta-Analysis of Statistics Assessment Not reported 2 high, 7 moderate, 13 low
and Review Instrument (MAStARI
Moreira, R. N. 2019 Cochrane Collaboration tool 5 low 3 high, 4 unsure
Nagendrababu, V. 2019 Cochrane Risk of Bias All low 1 high, 2 moderate, 13 low
Nasrabadi, N. 2020 Cochrane Risk of Bias All low
Neelakantan, P. 2019 Cochrane Risk of Bias Not reported 4 low
Neelakantan, P. 2019 Cochrane Risk of Bias All low
Neelakantan, P. 2020 Newcastle-Ottawa Scale Not reported
Ng, Y. L. 2007 No Not reported
Nixdorf, D. R. 2010 No Not reported
Olivieri, J. G. 2020 Newcastle-Ottawa scale Not reported
Pak, J. G. 2011 No Not reported
Panitvisai, P. 2010 CASP, Critical Appraisal Skills Not reported
Programme
Peng, L. 2007 No Not reported
Pourhajibagher, M. 2019 Cochrane Risk of Bias All low 12 low
Ruksakiet, K. 2020 Cochrane Risk of Bias All low 4 low, 4 unclear
Sadaf, D. 2020 Cochrane Risk of Bias All low
Sathorn, C. 2005 No Not reported
Sathorn, C. 2007 No Not reported
Schaeffer, M. A. 2005 No Not reported
Schwendicke, F. 2017 Cochrane Risk of Bias 28 low, 1 high 6 low, 23 unclear/high
Shakiba, B. 2017 Wong Scale, revised Not reported
Siddiqui, S. H. 2013 No Not reported
Silva, E. R. G. 2019 Cochrane Risk of Bias Not reported
Smith, E. A. 2017 Cochrane Collaboration tool All low 7 moderate, 8 high
Spohr, A. R. 2019 Cochrane Risk of Bias 6 low, 7 unclear
Suneelkumar, C. 2018 Cochrane Collaboration tool 4 low, 1 unsure 1 low, 4 unclear
Su, Y. 2011 Cochrane Risk of Bias Not reported
Susila, A. 2019 described in paper Not reported 6 low, 4 moderate, 7 high
Torabinejad, M. 2007 No Not reported
Torabinejad, M. 2009 No Not reported
Trindade, A. C. 2015 No Not reported
Wong, A. W. 2017 Cochrane Risk of Bias All low
Yaylali, I. E. 2018 Cochrane Risk of Bias All low 1 low, 3 unclear, 1 high
perspective. The patient-centred outcomes are relevant Strengths of review

both from the patients' point of view and for society and
healthcare planning. Development of COSET would • The present review provides a broad overview of re-
hopefully increase awareness and reporting on these do- ported outcomes and outcome measures in studies re-
mains in the future. lated to non-surgical root canal treatment.
|
• A transparent and reproducible methodology was em- survival, physiological and clinical outcomes, life impact,
ployed throughout the literature search, study selection, use of resource, and adverse events. Most studies reported
and data extraction. on physiological and clinical outcomes, in particular as-
• The review adopted a medical research taxonomy to sessment of pain and/or radiographic healing. The meas-
summarize outcome into a format compatible with core urement tools, scales, thresholds, and follow-up periods
outcome set development (Dodd et al., 2018). varied greatly within each outcome, making systematic
comparison across studies complicated. Less than 40% of
the included reviews reported on risk of selective report-
Limitations of review ing. Consequently, selective reporting bias could not be
ruled out. The presented systematic information on the
• Literature search was limited to systematic reviews pub- reported outcomes, measurement tools and scales, and
lished in English. This was done for practical reasons length of follow-up may guide the planning of future re-
and may have excluded research published in other search studies. Most importantly, the heterogeneity in the
languages. reported outcomes amongst studies warrants the develop-
• The scoping review does not perform critical appraisal of ment of a COS for non-surgical root canal treatment.
neither the original studies nor the systematic reviews.
Thus, the problem of selective reporting bias may be more AUTHOR CONTRIBUTIONS
extensive, as selective reporting may have occurred both in LLK and CK performed all analyses and wrote the paper.
the original study, in the systematic review, and eventually IEK, VN and HFD were project leads and developed over-
in the present scoping review (Kirkham et al., 2010). arching strategy. All authors commented on the manu-
• Furthermore, missing data and/or misreporting of data script and approved the final version.
may have increased in systematic reviews, as outcome
details from the original studies, for example follow-up CONFLICT OF INTEREST
time, outcome thresholds, may have been adjusted or No conflicts of interests.
left out, to fit the aim of a specific systematic review.
• A scoping review, per definition, does not perform criti- DATA AVAILABILITY STATEMENT
cal appraisal of neither the original studies nor the sys- Data sharing not applicable - no new data generated.
tematic reviews. Thus, selective reporting bias may have
occurred both in the original study, in the systematic REGISTRATION
review, and eventually in the present scoping review Core Outcome Measures in Effectiveness Trials (COMET)
(Azarpazhooh, Cardoso, et al., 2022). database (registration No. 1879).
ETHICAL STATEMENT
Future directions No ethical considerations were relevant.
Information from the present study will be used in Phase ORCID

2 of the development of COSET, in the consensus process Lise-Lotte Kirkevang https://orcid.
where the Delphi methodology and semi-structured inter- org/0000-0001-7811-2473
views will be used to agree on the most important outcomes Ikhlas A. El Karim https://orcid.
to define a COS for non-surgical root canal treatment (El org/0000-0002-5314-7378
Karim et al., 2021). Until this is developed, the researcher Henry Fergus Duncan https://orcid.
will have to continue to identify the outcomes used previ- org/0000-0001-8690-2379
ously and individually determine what is best suited for their Venkateshbabu Nagendrababu https://orcid.
specific research question. Hopefully, this review may guide org/0000-0003-3783-3156
researchers in that respect. Furthermore, this review points Casper Kruse https://orcid.org/0000-0003-0317-093X
at the necessity to include more patient-reported outcomes,
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viously published systematic reviews evaluating the outcome I.A., Duncan, H.F., Nagendrababu, V. & Kruse, C.
of endodontic treatment. International Endodontic Journal, 42, (2022) Outcomes reporting in systematic reviews on
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13652591, 2022, 11, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/iej.13812 by Cochrane Romania, Wiley Online Library on [11/11/2022].

Outcomes reporting in systematic reviews on non-­surgical

Lise-­Lotte Kirkevang1 | Ikhlas A. El Karim2 | Henry Fergus Duncan3 |

I N T RO DU CT ION possible benefits from evidence synthesis in systematic

Selection criteria of Science, Cochrane Database of Systematic Reviews.

969 studies excluded (initial

601 studies screened on title and

149 full-text studies assessed for

T A B L E 3 Overview of included systematic reviews

Cope, A. L. 2014 United Cochrane To evaluate the effects of Pain, pain on Y

Kruse, C. 2015 Denmark International To evaluate the diagnostic Radiographic healing. N

Ng, Y. L. 2008 United International To carry out meta-­analyses to Success based on Y

Sathorn, C. 2007 Australia International To determine to what extent Positive bacterial Y

Smith, E. A. 2017 USA Journal of To address the following: Postop pain. Y

T A B L E 4 Core area: Tooth survival

T A B L E 5 Core area: Physiological and clinical outcomes

Reported outcome measure

Smith et al. (2017; 5 studies)

Reported outcome measure

Susila & Minu (2019; 1 study)

Neelakantan, Ahmed, et al. (2019; 1 study)

Reported outcome measure

Sathorn et al. (2005; 1 study)

Su et al. (2011; 6 studies) (6 months–­5 years)

Reported outcome measure

Periapical radiographs 1 up to 2 years Mello et al. (2019; 1 study+)

T A B L E 6 Core area: Life impact

Reported outcome measure

T A B L E 7 Core area: Resource use

Reported outcome measure

T A B L E 8 Core area: Adverse effects

Method for assessing risk of bias Selective reporting risk

perspective. The patient-­centred outcomes are relevant Strengths of review

Information from the present study will be used in Phase ORCID

(PRISMA-­ScR): checklist and explanation. Annals of Internal

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Outcomes reporting in systematic reviews on non-surgical

Lise-Lotte Kirkevang1 | Ikhlas A. El Karim2 | Henry Fergus Duncan3 |

Ng, Y. L. 2008 United International To carry out meta-analyses to Success based on Y

Su et al. (2011; 6 studies) (6 months–5 years)

perspective. The patient-centred outcomes are relevant Strengths of review

(PRISMA-ScR): checklist and explanation. Annals of Internal